ACA Blog

Jan 30, 2013

PsychoFARMacology – There are often alternatives to a psychiatric referral. Part one of two.

As clinicians we undoubtedly do everything we can to help our clients. Many times this help comes in the form of “traditional” talk therapy and related interventions but there are times when behavioral interventions alone will not do the job. There are times when level of anxiety, depression (the most common reasons many enter treatment) reach a level that a client will need to be assessed for either short or long term medical interventions. The most typical referral is to a Psychiatrist or general practitioner who will do quick in office assessments and prescribe some combinations of medications in an attempt to relieve the symptoms. Many clinicians feel this is their only alternative, and in severe cases such as Schizophrenia, this would often be considered the most advantageous, but in many other cases there are options that we may not have tapped into.

Most of us I would assume had at least one Psychopharmacology course when on our way to LPC, LMHC or whatever license you have or are pursuing, some of you never had but likely have at least a cursory knowledge of how medications work (the good ole blood brain barrier, receptors, dendrites and the like). We know that many modern medications are synthesized versions of medicinal treatments found in nature and used almost forever. Think of many modern medicines as nothing more than steroid injected plasticized nature. They are bigger and stronger and without the nature but generally are based on the actions of the natural predecessors. Only because they are made not by nature but by man, they can be marketed, trademarked, patented and otherwise used to make a bazillion bucks. In some cases these changes in the lab make for a far better product, many times they do not. Most factory made fixes come with a whole list of potentially fatal side effects not found in their natural versions.

Take Valerian root for example. Have you heard of it? No? Eh, don’t feel badly, there is little profit in it. Have you heard of Valium? Yup. You guessed it. Valerian root (there are a few different ways you may see it spelled) is the precursor to Valium. Both are good at calming, encouraging rest etc. but one comes from nature, is non addictive, reacts subtly and the other is made in a factory, is very addictive because it works well, super quickly and is very potent. The factory made one is great for acute situations such as extreme panic attacks; the natural one is great as an all around calmative. It can be taken as a capsule or tea, and possibly in other ways as well (I have heard of some folks baking with it but have no idea if that is effective). It is also used to promote a good night’s sleep, one that may not be longer but one that is more restorative.

Ever hear of 5HTP? Ok, neither had I until I consulted a Naturopathic Doctor (ND). It seems that this natural substance has some of the same uses as such things as Lexapro but without the side effects. It has an effective dose of 300-400 mg but I have seen reports of people who were on small doses of Lexapro getting relief with as little as 50MG per day.

There is some concern that these natural treatments lack the same rigorous studies as their pharmaceutical brothers and there is merit in that. Others are concerned that because they are not medications and can be picked up often times at a health food store that they can be misused. This can be an issue as well. As clinicians, it is my firm belief however that in many cases the use of non medication based interventions is a wise choice. To do this, it is recommended that one find an ND, fully qualified Holistic medicine doctor or equivalent that they can work with and establish a referral network. Whereas years ago it was unheard of to find such a doc that worked with insurance panels, more and more of them have been in recent times.

Cost can be a factor but one that can often times be addressed easily if the client has even the most basic financial ability. Though not covered by insurance companies, many if not most of the natural remedies cost little more than the client’s normal copayment for prescriptions. Often times they cost less (as was the case of a client who switched to 5HTP from Lexapro. The insurance company did not have Lexapro on their preferred formulary so they punished, um, I mean offered the medication at a much larger ($75 instead of $20 per prescription copayment) cost to the client. The 5HTP which was not covered at all cost around 100 dollars but had enough in the bottle to last 2-3 months. In the case of Valerian, it costs from about 4 -20 dollars depending on where it is purchased, the dosage and the markup. I have found that as predicted, designer stores have designer priced Valerian and discount stores have the same. Typically the quality is about the same.

For those who believe in the ability of Mother Nature to provide for the most part, there are many references available, some referred to as the bible of natural remedies. Though these books are very informative they should not be used, in my opinion as a replacement for an expert. Conversely, a clinician who reads and or refers to it often should not consider themselves proficient enough to make recommendations to their clients. Instead make the appropriate referrals. In some cases, these books can be left in the waiting area as part of a lending library but again, making the appropriate referrals can help ensure quality care and keep you working within the scope of your license (and liability insurance).
Next time you find yourself about to make that referral, explore this option as well. You never know when you can find some farm grown resources as opposed to using harsh potentially caustic and side effect riddles chemical treatments.

Part Two will look into the therapeutic benefits of farm and garden based activities. See you at the farm.


Warren Corson III (Doc Warren) is a counselor, writer and the clinical & executive director of Community Counseling of Central CT and Pillwillop Therapeutic Farm (www.docwarren.org).

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